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First of an occasional series investigating how police have become the front line in dealing with the mentally ill.

Officer Robert Yeates had crossed paths with her before. She was mentally ill, and when off her lithium, the caring mother and grandmother would turn violent and suicidal.

Charlene McNally Fears was so out of control on Aug. 1 she tore apart her son's bedroom and, in an act impossible to fathom, stabbed her trusting 4-year-old grandson in the chest while whispering “it's OK, it's OK.”

Little Manny's mother, hearing his cries, burst in to yank him away. She laid him out on the porch to await an ambulance. Then she flagged down Yeates, passing by in his squad car.

It was up to Yeates to subdue and arrest Fears.

He found her inside the home in Black Rock, staring him down from 14 feet away. Her chin was down, her breathing heavy, Yeates wrote in a statement later.

Blood covered her white shirt and dripped from the knives in each hand. She wanted her life to end right there.

“NOOO,” she yelled, advancing in blood-spattered socks. “You're going to have to shoot me. Go on ... shoot me.”

Again he told her to drop the knives. Again she refused.

Still closing ground, she raised the blades.

The first shot hit the left side of her chest and spun her. The second coursed through her torso from right to left, and her bouts with depression and bipolar disorder were over.

No one faulted the officer for shooting Charlene Fears, not even her family. A grand jury found the gunfire justified. But it was another messy, fatal outcome to a police call involving someone with a serious mental illness. This time, the person took a life, that of the grandson she usually doted upon.

Police today are the front line in the nation's mental health system. Big psychiatric centers have been mothballed in favor of community clinics ill-suited for people who forgo medicines and don't show for appointments because they don't think they are sick.

So police decide what to do with someone hearing voices in their head, shouting threats or raising a knife.

Or with someone diagnosed with a mental illness who is simply sad, confused or urinating in the street.

Jail? The hospital? The care of a friend? Deadly force?

Should this be the job of police?

“What used to be dealt with by the medical community years ago is now dumped on criminal justice. And it's just caused a nightmare,” said Michael Biasotti, head of the New York State Association of Police Chiefs.

“No cop wants to be involved in putting a severely mentally ill person in jail,” he said. “But they respond, and a lot of times in the response, they don't know what the person's mental status is. So you pull up, and the guy has a weapon and comes at you. And the next thing you know ... it's a shame.”

Weeks before the mass killings in Newtown, Conn., shined a new light on mental illness in America and on the nation's gun laws, The Buffalo News began examining how police are tested as today's community mental health workers. Among the findings:

• Nearly half of the people killed by police north of New York City over a five-year period – 17 of 36 – suffered from a mental problem or were emotionally disturbed. A few, such as Laura J. Pettey in Watertown, Justin Arnold in Canastota and Charlene Fears in Buffalo, enlisted police to kill them by aiming weapons at the officers.

• Prisons and jails have become quasi-psychiatric centers. Researchers estimate that at least 17 percent of jail inmates are seriously mentally ill, a percentage three times greater than the public at large. In New York's prisons, the state Office of Mental Health treats one out of every seven inmates, nearly 8,000 people. The percentage of state inmates with some type of “mental health problem,” including substance abuse, is much higher – 56 percent, according to the U.S. Bureau of Justice Statistics. That's five times greater than the public at large.

• At least 500 times each year, police in Erie County escort or wrestle disturbed people who are a danger to themselves or others into psychiatric emergency rooms. Some town and city departments deal with the same people dozens of times, usually for minor infractions.

• A police cadet's basic training in handling the mentally ill has changed little in more than a generation. The training takes up just two or three days of a multi-week course at New York's police academies.

• Police are busy with mentally ill people because families are frustrated in attempts to prod their loved ones into treatment. It's not uncommon for someone with a serious mental illness to spurn their medicines because they hate the side effects and don't understand they are sick. With the patient in a spiral, some families welcome police because they have nowhere to turn.

• New York still runs more psychiatric centers than any other state, but more closings are expected. Gov. Andrew M. Cuomo intends to consolidate them into regional “centers of excellence” for behavioral health programs and would plow the savings into community-based outpatient care – the strategy that has led to uneven results for people with serious mental illness.

“The mental health system right now is failing not just the patient, but it's failing the family members who care for them ... and unfortunately our society,” said Victor Campione, whose law enforcement career included work as a police officer and as a state corrections officer. His brother, diagnosed with paranoid schizophrenia, was off his medication and adrift when he provoked a hail of police gunfire in Syracuse in 2011 and was killed.

D.J. Jaffe saw how difficult it was for a mentally ill sister-in-law to find treatment. He founded the Mental Illness Policy Org in New York City, his think-tank about the treatment of people with serious mental illness.

“In the mental health field, they will say we have to train police better to handle the mentally ill,” Jaffe said. “What we should be doing is training the mental health system to handle people with serious mental illness.”

A crush of repeat offenders

“John” lives with his mother in Cheektowaga, near Amherst. With bipolar disorder, John has intense mood swings far more severe than the ups and downs that most people go through. Because his mother did not want John interviewed, The News agreed to use a pseudonym.

Police records show officers have arrested him 19 times and escorted him 15 times to a psychiatric emergency room. In total, they have responded to 79 calls involving John.

That's in Cheektowaga. Police in Amherst, Depew, Evans and Buffalo have responded 10 other times in their municipalities.

John is just 19 years old, and those are the calls only on his adult record. Doctors and police say there are many more mentally ill people with similar histories. Officers shuttle them between jails and hospitals, usually after outbursts and nuisance crimes. John has been dangerous, but he also seems to know his pattern cannot continue. One night last year, he broke down outside the Cheektowaga police station when released from custody.

“I want to die,” he yelled. “I want to go to heaven. I am living in hell.”

His mother has been overwhelmed.

“I love my son. He's such a good kid. He's a smart kid. He has been through hell,” she said. “He just wants to be like everybody, and to have friends like everybody else. It breaks my heart.”

From asylums to cells

The revolution that put people such as John and Charlene Fears back on the street time and again, making them a police concern, started in the 1960s.

Activists who wanted more dignity for patients – to give them the chance to live in the community and have a say over their treatment – persuaded states to close big asylums and psychiatric centers. States went along for several reasons. Among them: While state budgets paid for state-run psychiatric centers, new federal safety-net programs could support community-based treatment. States laid much of their cost to care for the seriously mentally ill on the federal government.

In 1955, states and counties made 558,000 beds available for mentally ill individuals. By 2005, the number had plummeted to about 53,000, and it's around 40,000 today, said E. Fuller Torrey, a research psychiatrist in Chevy Chase, Md., who in the fall will publish his latest book about the changes.

When adjusting for population growth over the decades, it was as though the nation lost 19 of every 20 beds set up for the seriously mentally ill, Torrey said during a recent speech in Getzville.

While the transformation benefited many patients, some severely mentally ill people still spin on and off their medicines, cannot comprehend that they are ill and pose a threat to themselves or others while resisting long-term treatment. Police arrest them dozens of times.

Do people like this need the structure of an institution?

“There is one. It's the Holding Center. And it's the Department of Corrections,” lamented Dr. Michael Cummings, director of community psychiatry for the University at Buffalo medical school, which provides psychiatrist services to Erie County Medical Center's Community Psychiatric Emergency Program. Cummings also is a consultant to local detention centers, such as the Erie County Holding Center and the county's Youth Detention Center.

“There are any number of individuals who years ago would not be in the Holding Center,” Cummings continued. “They would be on the grounds of a psychiatric state hospital. They often come in and out based on relatively minor and modest crimes. They have incredible discontinuity in their medication.”

The Niagara County Jail spends about 40 percent of its medicinal budget – or about $140,000 a year – on psychotropic drugs for inmates with a diagnosed mental illness, Chief Administrator Kevin M. Smith said.

“There are always going to be some where you are basically dealing with an adult with the mental capacity of a 7-year-old, or lower,” Smith said. “They don't belong in jail, no. But we treat them to the best of our ability. That can go as far as officers having to walk them into the shower, or officers having to clean their cell on a daily basis.”

Multiple arrests

Cheektowaga Police Chief David J. Zack suspects the number of police calls triggered by people with mental illness is on the rise. He's not the only police chief who thinks that.

Biasotti, the head of the state police chiefs' association, surveyed police administrators nationwide for a master's thesis. Eighty-four percent of the respondents said they have seen the mentally ill population in their communities increase over their careers; 76 percent said they have seen the number of mentally ill detainees rise; 61 percent have seen the numbers of suicides grow.

Few local police agencies count the calls in which a person's mental health was the root issue. A telling statistic might be found in the number of times police take people to psychiatric emergency rooms, but no state agency counts that traffic in New York.

After days of research, the staff at ECMC determined that police last year transported 502 people involuntarily to ECMC's busy psychiatric emergency room, and that total represented a 35 percent climb over the prior year. Still, those numbers don't reveal the full volume because it's not uncommon for people at the last minute to enter the psychiatric emergency room voluntarily because they are going in anyway.

The vast majority of seriously mentally ill people are not violent or dangerous when taking their medicines and seeing counselors and psychiatrists. Their illnesses, unlike, say, diabetes or hypertension, are more complex to diagnose and treat, and they carry a stigma. To a large degree, the fates of these seriously mentally ill people depend on the police.

“The best way, we know from experience here, is that you cannot arrest your way out of this problem,” Zack said. “So if you are not going to arrest, what can we do?”

Weeks later, Zack decided that each of his approximately 130 officers will receive specialized crisis-intervention training that helps prevent calls involving people who are mentally ill from escalating and helps steer people into treatment rather than jail. Cheektowaga is the first Erie County police department to make this move.

Two mental health systems

In Niagara Falls, Thomas P. Jamieson's hobby was making Molotov cocktails. When his trove was discovered, police evacuated his neighborhood in April 2012 to remove up to 20 of the weapons. His case, assigned to mental health court, led to his placement in the Buffalo Psychiatric Center rather than the Niagara County Jail.

It was a path that many families, desperate to help their loved ones, would prefer in an effort to get them into monitored treatment or an institution. Toward this end, the police have become pivotal gatekeepers for the seriously mentally ill. Plus, they are easier to find than psychiatrists.

“For a lot of families, the most effective solution to a serious dilemma is the patient gets arrested without being beat up, shot, killed, hurt or whatever, and ends up in a mental health court,” said Lynne Shuster, who was active for years in the National Alliance on Mental Illness chapter for Buffalo and Erie County.

“The mental health court judges follow these people and hold the mental health agencies accountable, which they are not real happy about necessarily,” she said.

Jaffe, founder of the Mental Health Policy Org, sees a disparity.

“New York State now basically has two mental health systems,” he said “You have the one run by the Office of Mental Health and the counties that basically helps improve mental health. And then you have the system for people with serious mental illness, and that is being run by police and corrections and judges.

“Basically OMH and the mental health system have decided they are going to focus on the highest functioning,” he said, “and the results of that is the off-loading of the others to police and criminal justice.”

Jaffe said events like the deaths of Charlene Fears and her grandson occur because neither the hospital nor a government agency is expected to follow up with a once-dangerous patient when released from inpatient care. They are usually released to the outpatient care offered by a mental health center, but if they slide backward and go off their medication, which is common, no government agency is watching. Their cycle is free to repeat itself.

“Her case is exceedingly typical,” Jaffe said of Fears. “The criminal justice system had to go where the mental health system no longer treads, to the aid of somebody with serious mental illness. And tragedy resulted. But the tragedy did not result because police went in. The tragedy resulted because the mental health system didn't.”

Horrible results

In calls involving the mentally ill, police try to get it right. Sometimes they don't.

When Michael Bennett, diagnosed with schizophrenia, walked naked down a West Side street in July 2002, Buffalo police took him to the Holding Center rather than ECMC. In the jail, Bennett tried to hang himself with a shoelace and repeatedly jumped off his toilet, smashing his head into the bars. The state Commission of Correction attributed his death to traumatic asphyxia: A shoe had been pressed into his back when jail deputies tried to control him. Erie County settled the wrongful death case for $1 million.

Every corner of the nation has horror stories that played out in jails or on the street. Just look at newspaper accounts in upstate New York:

• In Schenectady, police in 2009 shoot and kill a man with schizophrenia who was off his medicine and refused to drop a knife.

• Rochester police in June 2012 shoot and kill a man with bipolar disorder – off his medication – who fired a rifle at them after a domestic incident.

• Syracuse police in May 2011 shoot and kill Benjamin Campione, who aimed a pellet gun at them. Campione was off his medicine and slipping deeper into paranoid schizophrenia, said his brother, Victor, who had been desperate to find him help.

“You can't understand the terror, the fear, the frustration of a family member that has a son or a daughter that has been diagnosed as a paranoid schizophrenic or a manic depressive, and you can't get any help,” he said. “You are waiting for that phone call that they have been picked up again, or you are waiting for that phone call that they have killed themselves or they've harmed somebody else. You live with that every day.”

A federal government statistic hints at a dramatic jump in the number of troubled people who resort to suicide by cop: In the mid-1970s, roughly one of every three victims of a justifiable police homicide had attacked the officer. By 2005, it was double that – two out of every three.

Every year in America, police kill an average of 24 people whom officers did not intend to arrest, according to a Justice Department study. In most of those cases, the task of bringing someone to a hospital for a mental evaluation turned ugly.

“We go to calls all the time, on a daily basis, where we interact with the mentally ill. We do the best we can,” Chief Deputy Steven Preisch of the Niagara County Sheriff's Office said. “We have to be realistic. We are police officers. A lot of times we are dealing with individuals who are going to need a lifetime of medication or supervision or counseling or something to help. A lot of times we get called in on the weekends, or holidays or in the middle of the night when no one else is available. And we are basically a Band-Aid.”

Fear of the mentally ill

While some families welcome police involvement, the patients, also called consumers, do not necessarily feel the same way. The arrival of officers with badges and guns can cast the mentally ill as criminals.

“They sent the police for me once,” said Lauren Tenney who calls herself a “psychiatric survivor” and an advocate for the “liberation movement” that fights for the rights of people in the system. Tenney has experienced and rejected the tools of psychiatry, especially the drugs that doctors prescribe.

The police came for her in Manhattan, around 1992. She was 20 years old and had been diagnosed with a mental illness.

“I was sad. I was crying. The person that I was with flipped out because they couldn't deal with the fact that I was crying. And so they called the psychiatrist, and the psychiatrist told them to call the police. The police showed up, six or eight of them maybe, with those plastic screen things, you know? And helmets ...

“It was frightening. Having people come in prepared for who knows what didn't in any way help me feel more like a person. And having to be walked out by police, in all this gear, with people seeing it, it deepens the justification in peoples' minds ... that we are dangerous. All I was doing was crying.”

Said Tenney: “I do think that police and people in general are afraid of us.”

Some officers acknowledge they do find calls involving the mentally ill scary. But that doesn't mean the seriously mentally ill are inherently more dangerous when treated. Studies have found that people with mental illness are more likely to be victims of crimes than perpetrators. Police are more likely to harm the mentally ill than be harmed by them.

A Buffalo News analysis found that from 2008 through 2012, police north of New York City killed 17 people who had mental trouble or were emotionally disturbed.

The News found that four upstate police were slain by gunfire over the same period. One of the four, Detective Alexander Ridley of Mount Vernon, was killed by law enforcement officers who mistook him for a suspect.

Tenney's views reveal a philosophical divide in the mental health community: Should treatment be forced on the mentally ill?

Generally, the legal answer is no, unless the person appears to be a threat to themselves or others. Police can then take them to a hospital for what usually turns out to be a short-term stay.

But with someone, say, eating from a dumpster or ranting on the street to no one in particular, cops have limited power.

'I'm a loser'

Charlene Fears was dangerous. She once pulled a knife on her husband. She fought with a neighbor. She threatened suicide. “It was always some chaotic stuff at that house,” a neighbor later told police.

Fears had spent time in psychiatric care and was released in the hope that she would take her lithium.

But she didn't like the side effects. Her husband told detectives that his wife thought the drug made her hair fall out.

Her torment worsened until her final acts on Aug. 1.

A detective examining her body at 195 Esser St. in Black Rock found she had slashed her wrists some time before squaring off with Officer Yeates.